Instructional Strategies: Case Studies

Case Study 1

Mr. Kim is a 55 year old Korean male admitted to the hospital several days ago with uncontrolled pain, nausea and vomiting. On exam the patient was extremely emaciated and had a protruding mass in the mid-epigastric area. The family was at the bedside, the patient’s wife and 2 daughters. The patient’s eldest daughter asked to speak to you alone. She confided in you that about one year ago her father returned to Korea for medical work-up of abdominal pain and weight loss. Her father did not want to burden the family with the health care related costs and went to back to Korea and was seen there by a friend who practices tradition medicine by using Han Yak.

He was diagnosed gastric cancer and was treated with herbal remedies. Since his return the patient continued to lose weight and became very lethargic, so that he was unable to work at the family’s dry cleaning store. Her mother now works at the store full-time and she and the daughters attend to the father. Over the last several weeks that patient has only been able to tolerate porridge and liquids. Over the last several days he has been unable to eat anything and he has been in severe pain. The family is aware that the father is dying but does not want him to know and ask you not to mention anything and treat his pain.

Questions for Discussion

1. Why would the patient go back to his home country for medical care?

2. How would you ascertain how much the patient knows about his illness and how much he would want to know or be involved in decision making?

3. How could assistance be provided to this patient and his family prior to discharge?